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CORK Bibliography: Ethics

100 citations. January 2009 to present

Prepared: March 2012

Babor TF. Alcohol research and the alcoholic beverage industry: Issues, concerns and conflicts of interest. (review). Addiction 104(Supplement 1): 34-47, 2009. (59 refs.)

Using terms of justification such as 'corporate social responsibility' and 'partnerships with the public health community', the alcoholic beverage industry (mainly large producers, trade associations and 'social aspects' organizations) funds a variety of scientific activities that involve or overlap with the work of independent scientists. The aim of this paper is to evaluate the ethical, professional and scientific challenges that have emerged from industry involvement in alcohol science. Source material came from an extensive review of organizational websites, newspaper articles, journal papers, letters to the editor, editorials, books, book chapters and unpublished documents. Industry involvement in alcohol science was identified in seven areas: (i) sponsorship of research funding organizations; (ii) direct financing of university-based scientists and centers; (iii) studies conducted through contract research organizations; (iv) research conducted by trade organizations and social aspects/public relations organizations; (v) efforts to influence public perceptions of research, research findings and alcohol policies; (vi) publication of scientific documents and support of scientific journals; and (vii) sponsorship of scientific conferences and presentations at conferences. While industry involvement in research activities is increasing, it constitutes currently a rather small direct investment in scientific research, one that is unlikely to contribute to alcohol science, lead to scientific breakthroughs or reduce the burden of alcohol-related illness. At best, the scientific activities funded by the alcoholic beverage industry provide financial support and small consulting fees for basic and behavioral scientists engaged in alcohol research; at worst, the industry's scientific activities confuse public discussion of health issues and policy options, raise questions about the objectivity of industry-supported alcohol scientists and provide industry with a convenient way to demonstrate 'corporate responsibility' in its attempts to avoid taxation and regulation.

Copyright 2009, Society for the Study of Addiction to Alcohol and Other Drugs

Babor TF. Towards a common standard for conflict of interest disclosure. (editorial). Addiction 104(11): 1777-1778, 2009. (10 refs.)

Backhouse SH; McKenna J. Doping in sport: A review of medical practitioners' knowledge, attitudes and beliefs. (review). International Journal of Drug Policy 22(3): 198-202, 2011. (35 refs.)

Background: Central to the work of many medical practitioners is the provision of pharmaceutical support for patients. Patients can include athletes who are subject to anti-doping rules and regulations which prohibit the use of certain substances in and out of competition. This paper examines the evidence on medical practitioners' knowledge, attitudes and beliefs towards doping in sport. Methods: A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and 2010. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. Results: Six studies met the inclusion criteria and were examined in detail. Samples reflected a range of medical practitioners drawn from the UK, France (2), Greece, Italy and Ireland. The investigations varied with respect to outcome focus and quality of evidence presented. Conclusion: Whilst the extant empirical research posits a negative attitude towards illegal performance enhancement combined with a positive inclination towards doping prevention, it also exposes a limited knowledge of anti-doping rules and regulations. Insufficient education, leading to a lack of awareness and understanding, could render this professional group at risk of doping offences considering Article 2.8 of the World Anti-Doping Agency Code (WADC). Moreover, in light of the incongruence between professional medical codes and WADC Article 2.8, medical professionals may face doping dilemmas and therefore further discourse is required. At present, the current evidence-base makes it difficult to plan developmentally appropriate education to span the exposure spectrum. Addressing this situation appears warranted.

Copyright 2011, Elsevier Science

Bakke O; Endal D. Vested interests in addiction research and policy. Alcohol policies out of context: Drinks industry supplanting government role in alcohol policies in sub-Saharan Africa. Addiction 105(1): 22-28, 2010. (31 refs.)

Background: In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a 'partnership' role with governments to design national alcohol policies. Methodology: A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods. Findings: The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source. Conclusions: The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine 'active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'.

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs

Barbour V; Clark J; Jones S; Peiperl L; Veitch E; Yamey G. A new policy on tobacco papers. (editorial). PLoS Medicine 7(2): e1000237, 2010. (9 refs.)

This editorial announces a new policy in respect to publications on tobacco use. The Journal will no longer consider papers where support, in whole or in part, for the study or the researchers comes from a tobacco company. This is done for two reasons. First, tobacco is indisputably bad for health. Half of all smokers will die of tobacco use. Unlike the food and pharmaceutical industries, the business of tobacco involves selling a product for which there is no possible health benefit. Tobacco interests in research cannot have a health aim-if they did, tobacco companies would be better off shutting down business-and therefore health research sponsored by tobacco companies is essentially advertising. Publication is part of tobacco company marketing, and we believe it would be irresponsible to act as part of the machinery that enhances the reputation of an industry producing health-harming products. Secondly, the Journal remainsconcerned about the industry's long-standing attempts to distort the science of and deflect attention away from the harmful effects of smoking. That the tobacco industry has behaved disreputably-denying the harms of its products, campaigning against smoking bans, marketing to young people, and hiring public relations firms, consultants, and front groups to enhance the public credibility of their work-is well documented. There is no reason to believe that these direct assaults on human health will not continue, and we do not wish to provide a forum for companies' attempts to manipulate the science on tobacco's harms.

Copyright 2010, Public Library System

Barkus E; Murray RM. Substance use in adolescence and psychosis: Clarifying the relationship. (review). Annual Review Of Clinical Psychology 6: 365-389, 2010. (246 refs.)

Adolescence is a time of exploration of the self, and this exploration may involve the use of alcohol and drugs. Sadly, for some, adolescence also marks the first signs of a psychosis. The temporal proximity between the onset of substance use and of psychosis has been the cause of much debate. Here we review the association of alcohol, cannabis, stimulants, and other drugs with psychosis, and we conclude that the use of cannabis and the amphetamines significantly contributes to the risk of psychosis.

Copyright 2010, Annual Reviews

Baumrucker S; Mingle P; Harrington D; Stolick M; Carter GT; Oertli KA. Medical marijuana and organ transplantation: drug of abuse, or medical necessity? American Journal of Hospice & Palliative Medicine 28(2): 130-134, 2011. (13 refs.)

This article focuses upon a liver transplant candidate who was removed from the transplant list as the result of a laboratory test indicating his use of marijuana, which was defined as "using drugs of abuse." The ethics team at the hospital was not consulted nor made aware of the case. Of note, the patient was following the state law, allowing him to use marijuana to treat his pain, nausea, and vomiting, which turned out to be the only thing that worked. Despite following state laws, this statefunded university hospital refused to reconsider its decision. This was the case though physicians advocated for the patient and noted that there was no scientific literature showing any increased risk of organ damage or rejection from someone using marijuana. There are commentaries on this case from different members of the referring hospital care team: nurse, social worker, physician, a physician-ethicist, and chaplain.

Copyright 2011, Sage Publications

Benson P. Tobacco talk: Reflections on corporate power and the legal framing of consumption. Medical Anthropology Quarterly 24(4): 500-521, 2010. (67 refs.)

This article examines how North Carolina tobacco farmers think about the moral ambiguities of tobacco business. Drawing on ethnographic research with tobacco farmers and archival research on the tobacco industry, I specify the core psychological defense mechanisms that tobacco companies have crafted for people associated with the industry. I also document local social, cultural, and economic factors in rural North Carolina that underpin ongoing rural dependence on tobacco despite the negativity that surrounds tobacco and structural adjustments. This article contributes to our knowledge about tobacco farmers and tobacco farming communities, which is important for tobacco-control strategies. I reflect on ethical and economic paradoxes related to the rise of corporate social responsibility in the tobacco industry, where an official legal framing of consumption, focused on informed adult consumer autonomy and health education, is promoted to undermine more robust public health prevention efforts.

Copyright 2010, Wiley-Blackwell

Blumenson E; Nilsen E. Liberty lost: The moral case for marijuana law reform. Indiana Law Journal 85(1): 279-299, 2010. (115 refs.)

Marijuana policy analyses typically focus on the relative costs and benefits of present policy and its feasible alternatives. This Essay addresses a prior, threshold issue: whether marijuana criminal laws abridge fundamental individual rights, and if so, whether there are grounds that justify doing so. Over 700, 000 people are arrested annually for simple marijuana possession, a small but significant proportion of the 100 million Americans who have committed the same crime. In this Essay, we present a civil libertarian case for repealing marijuana possession laws. We put forward two arguments corresponding to the two distinct liberty concerns implicated by laws that both ban marijuana use and punish its users. The first argument opposes criminalization and demonstrates that marijuana use does not constitute the kind of wrongful conduct that is a prerequisite for just punishment. The second argument demonstrates that even in the absence of criminal penalties, prohibition of marijuana use violates a moral right to exercise autonomy in personal matters-a corollary to John Stuart Mill's harm principle in the utilitarian tradition, or, in the nonconsequentialist tradition, to the respect for personhood that was well described by the Supreme Court in its Lawrence v. Texas opinion. Both arguments are based on principles of justice that are uncontroversial in other contexts.

Copyright 2010, Indiana University School of Law

Booker RJ; Smith JE; Rodger MP. Packers, pushers and stuffers-managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. (review). Emergency Medicine Journal 26(5): 316-320, 2009. (35 refs.)

Body packing, pushing and stuffing are methods by which illicit drugs may be carried within the human body. Patients involved in these practices may present UK emergency departments with complex medical, legal and ethical considerations. This review article examines not only the evidence behind the clinical management of these patients, but also the legal powers afforded to the authorities to authorise the use of intimate searches and diagnostic imaging for forensic purposes. Serious complications from concealed drug packets are now rare, and most asymptomatic patients may be safely discharged from hospital after assessment. Emergency surgery is indicated for body packers with cocaine poisoning and for some cases of heroin poisoning. Urgent surgery is indicated for obstruction, perforation, the passage of packet fragments and failure of conservative treatment. Guidance is given for doctors who are faced with requests from the authorities to perform intimate searches and diagnostic imaging for forensic purposes.

Copyright 2009, BMJ Publishing

Bromage DI; McLauchlan DJ; Nightingale AK. Do cardiologists and cardiac surgeons need ethics? Achieving happiness for a drug user with endocarditis. (editorial). Heart 95(11): 885-887, 2009. (9 refs.)

Ethical dilemmas are commonplace in clinical cardiology. There has been a recent focus on ethical behaviour of cardiologists and debate about resource allocation and cost-effectiveness of new technologies. The case of an intravenous drug addict, with native aortic valve endocarditis complicated by a cerebral abscess and severe aortic regurgitation, is presented to illustrate some common ethical and moral dilemmas. The predominant theories in medical ethics, including the "Four-Principles Approach,'' is discussed, and a model to translate these ethical theories into a clinical decision-making tool is presented.

Copyright 2009, BMJ Publishing Group

Buchman DZ; Illes J; Reiner PB. The paradox of addiction neuroscience. Neuroethics 4(2, special issue): 65-77, 2011. (80 refs.)

Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Many scientists and mental health advocates scaffold this emerging knowledge by adding the imprimatur of disease, arguing that conceptualizing addiction as a "brain disease" will reduce stigma amongst the folk. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: the language makes room for individuals living with addiction to receive the same level of compassion and access to healthcare services as individuals living with other medical diseases, and promotes enlightened social and legal policies. However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others. In this paper, we examine the merits and limitations of adopting the language of neuroscience to describe addiction. We argue that the reframing of addiction in the language of neuroscience provides benefits such as the creation of empowered biosocial communities, but also creates a new set of risks, as descriptive neuroscience concepts are inseparable from historical attitudes and intuitions towards addiction and addicted persons. In particular, placing emphasis on the diseased brain may foster unintended harm by paradoxically increasing social distance towards the vulnerable group the term is intended to benefit.

Copyright 2011, Springer

Burch T; Wander N; Collin J. Uneasy money: the Instituto Carlos Slim de la Salud, tobacco philanthropy and conflict of interest in global health. Tobacco Control 19(6): E1-E9, 2010. (113 refs.)

In May 2007, the Instituto Carso de la Salad-now Instituto Carlos Slim de In Salud (ICSS)-was endowed with US$500 million to focus on priority health issues in Latin America, notably issues of 'globalisation and non-communicable diseases'. ICSS was soon criticised, however, on the grounds that its funding was derived from tobacco industry profits and that its founder Carlos Slim Helu remained art active industry principal. Collaboration with ICSS was said to run counter to the WHO Framework Convention on Tobacco Control, The Institute's then Executive President Julio Frenk disputed these charges. This research employs an archive of tobacco industry documents triangulated with materials horn commercial, media, regulatory and NGO sources to examine the financial relations between Slim and the tobacco industry. The paper analyses Slim's continuing service to the industry and role in ICSS. It demonstrates a prima facie conflict of interest between ICSS's health mission and its founder's involvement in cigarette manufacturing and marketing, reflected on ICSS's website as a resounding silence on issues of tobacco and health. It is concluded that the reliance of international health agencies upon the commercial sector requires more robust institutional policies to effectively regulate conflicts of interest.

Copyright 2010, BMJ Publishing

Campbell RB. A delicate diplomatic situation. (editorial). Journal of Clinical Epidemiology 63(8): 815-817, 2010. (31 refs.)

Carter A; Ambermoon P; Hall WD. Drug-induced impulse control disorders: A prospectus for neuroethical analysis. Neuroethics 4(2, special issue): 91-102, 2011. (90 refs.)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson's Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis.

Copyright 2011, Springer

Carter A; Bell E; Racine E; Hall W. Ethical issues raised by proposals to treat addiction using deep brain stimulation. Neuroethics 4(2, special issue): 129-142, 2011. (91 refs.)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a "cure" of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction.

Copyright 2011, Springer

Carter A; Hall W. Proposals to trial deep brain stimulation to treat addiction are premature. (editorial). Addiction 106(2): 235-237, 2011. (19 refs.)

Chapman S. Health and philanthropy: The tobacco connection. (editorial). Lancet 377(9759): 11-13, 2011. (16 refs.)

Chikritzhs T. Protecting the integrity of shared scientific knowledge: Is the conflict of interest statement enough? Addiction 105(2): 201-201, 2010. (14 refs.)

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs

Christensen SE. Health promotion and human right protection: Finding a balance for HIV testing policies in US state prisons. Journal of the Association of Nurses in AIDS Care 22(3): 238- 243, 2011. (25 refs.)

In 2008, approximately 1.5 million people were reported to be incarcerated in a prison in the United States (Maruschak, 2009). Previous research has shown that many incarcerated individuals engage in high-risk sexual behaviors and/or have a history of substance abuse (Centers for Disease Control and Prevention [CDC], n.d., para. 2), thereby putting them in a high-risk group for contracting HIV infection. As one would expect, this high-risk behavior has translated into startling statistics. According to the most recent U.S. Bureau of Justice report, the number of HIV-infected individuals living in the United States who are incarcerated is approximately 2.5 times higher than that of the general population (Maruschak, 2009). What is even more alarming is the fact that many of the infected individuals are unaware of their HIV status at the time of incarceration (Desai, Latta, Spaulding, Rich, & Flanigan, 2002). In addition to the high-risk behaviors engaged in by many of those who enter prison before their incarceration, once an individual is established within the prison setting, high-risk behaviors often continue. Many studies have examined the incidence of sexual activity in prisons; however, the results have been far from conclusive. Saum, Surratt, Inciardi, and Bennett (1995) reported a rate of 2%, whereas an earlier survey that was conducted when HIV was a newly emerging and unknown infection estimated a much higher rate of 65% (Wooden & Parker, 1982).

Copyright 2011, Elsevier Science

Christopher PP; Arikan R; Pinals DA; Fisher WH; Appelbaum PS. Evaluating psychiatric disability: Differences by forensic expertise. Journal of the American Academy of Psychiatry & Law 39(2): 183-188, 2011. (28 refs.)

The task of evaluating psychiatric disability poses several ethics-related and practical challenges for psychiatrists, especially when they are responding to a request from a third party for a disability evaluation on their own patient. This study sought to evaluate the differences in how forensic and nonforensic psychiatrists approach and view evaluations for Social Security disability benefits. Thirty-two forensic and 75 nonforensic psychiatrists were surveyed on their practice patterns and perceptions of role, objectivity, and dual agency in the disability evaluation process. Significant differences were found between forensic and nonforensic psychiatrists' perceptions of the dual-agency conflict, beliefs about who should perform evaluations, and beliefs about the weight given to different opinions when decisions of whether to award disability benefits are made. A minority of respondents in both groups reported having identified a patient as disabled, despite believing otherwise. The implications of these findings are discussed.

Copyright 2011, American Academy of Psychiatry & Law

Coors ME; Raymond KM. Substance use disorder genetic research: Investigators and participants grapple with the ethical issues. Psychiatric Genetics 19(2): 83-90, 2009. (60 refs.)

Objective: This qualitative research examined the ethical concerns regarding the psychosocial issues, research design and implementation, and application of psychiatric genetic research on substance use disorders (SUD) from multiple perspectives. Methods: A literature review of the bioethics literature related to psychiatric genetics and focus groups explored the ethical implications of SUD genetic research. Twenty-six National Institute on Drug Abuse funded principal investigators in the field of psychiatric genetic research, nine adolescent patients in residential SUD treatment, and 10 relatives of patients participated in focus groups (held separately). The focus groups were recorded, transcribed, and the content was analyzed. The themes that emerged from the literature and the focus group transcripts were organized by using NVIVO7, a software package designed to manage, analyze, and compare narrative data. Results Investigators and the literature expressed similar concerns regarding the ethical concerns associated with psychiatric genetic research including violation of privacy, misunderstanding about psychiatric genetics, stigmatization, commercialization, discrimination, eugenics, consequences of research on illegal behavior, unforeseen consequences, altered notion of individual responsibility, and others. Patients and their relatives showed little familiarity with the ethical issues as identified by professionals and little concern regarding most of the potential risks. The exception was apprehension associated with potential criminal justice uses of stored genetic information, in particular enforced therapy and stigmatization, which elicited some concern from all perspectives. Conclusion :The challenge for further research is to identify risks and benefits of SUD research that are germane in a behaviorally disinhibited population and devise effective tools to communicate information to participants through an improved informed consent process.

Copyright 2009, Lippincott, Williams & Wilkins

Corvo K; Dutton D; Chen WY. Do Duluth model interventions with perpetrators of domestic violence violate mental health professional ethics? Ethics and Behavior 19(4): 323-340, 2009. (63 refs.)

In spite of numerous studies of program outcomes finding little or no positive effect on violent behavior, the Duluth model remains the most common program type of interventions with perpetrators of domestic violence. In addition, Duluth model programs often ignore serious mental health and substance abuse issues present in perpetrators. These and other issues of possible threat to mental health professional ethics are reviewed in light of the court-mandated, compulsory nature of most Duluth model programs and client and victim expectations for program efficacy.

Copyright 2009, Lawrence Erlbaum

Davies JB; Rotgers F. Disclosure in the best interests of science? Or moral crusade? (editorial). Addiction 104(11): 1787-1788, 2009. (7 refs.)

This is a commentary on an article by Groozner et al, (pps 1779-1784) advocating a common standard for addiction journals in reporting and considering disclosure of conflict of interests.

Copyright 2009, Society for the Study of Addiction

Dingel MJ; Karkazis K; Koenig BA. Framing nicotine addiction as a "disease of the brain": Social and ethical consequences. Social Science Quarterly 92(5): 1363-1388, 2011. (122 refs.)

Objectives. In this article, we seek to better understand how a genomic vision of addiction may influence drug prevention and treatment. Though social influences on substance use and abuse (e. g., peer and family influence, socioeconomic status) are well documented, biomedical intervention is becoming increasingly technoscientific in nature. We wish to elucidate how emphasizing biological influences on substance use may lead to a vision of addiction as a phenomenon isolated within our bodies and neurochemistry, not lived daily within a complex social web of relationships and a particular political economy, including the tobacco industry, which aggressively markets products known to cause harm. Methods. We explore the emerging view of addiction as a "disease of the brain" in open-ended interviews with 86 stakeholders from the fields of nicotine research and tobacco control. Interview data were analyzed using standard qualitative techniques. Results. Most stakeholders hold a medicalized view of addiction. Though environmental variables are understood to be a primary cause of smoking initiation, the speed and strength with which addiction occurs is understood to be a largely biological process. Though stakeholders believe that an increased focus on addiction as a disease of the brain is not likely to lead to widespread unrealistic expectations for cessation therapies, they remain concerned that it may reinforce teenagers' expectations that quitting is not difficult. Finally, stakeholder responses indicate that genetic and neuroscientific research is unlikely to increase or decrease stigmatization, but will be used by interest groups to buttress their existing views of the stigma associated with smoking. Conclusion. We argue that the main potential harms of focusing on biological etiology stem from a concept of addiction that is disassociated from social context. Focusing on genetic testing and brain scans may lead one to overemphasize pharmaceutical "magic bullet cures" and underemphasize, and underfund, more traditional therapies and public health prevention strategies that have proven to be effective. Genetic research on addiction may fundamentally change our conception of deviance and our identities, and may thus transform our susceptibility to substance use into something isolated in our biology, not embedded in a biosocial context.

Copyright 2011, Wiley-Blackwell

Doab A; Topp L; Day CA; Dore GJ; Maher L. Clinical trial literacy among injecting drug users in Sydney, Australia: A pilot study. Contemporary Clinical Trials 30(5): 431-435, 2009. (25 refs.)

This pilot study examined knowledge, understanding and perceived acceptability of key methodological concepts in clinical trials among injecting drug users (IDUs) in Sydney, Australia. Participants were clinical trial-experienced (n=17) and trial-naive (n=99) IDUs recruited from community needle and syringe programs, and through institutions involved in clinical trials with IDU participants. Cross-sectional data were collected via a study-specific interviewer-administered survey. Following detailed verbal explanations, higher proportions of trial-experienced than trial-naive participants demonstrated an understanding of all clinical trial concepts assessed, including single blinding (94% versus 60%); placebo (94% versus 49%); equipoise (71% versus 60%); comparison (59% versus 46%); randomisation (59% versus 21%); and double blinding (47% versus 3%). Multivariate analyses indicated a better understanding among trial-experienced participants. Participants who demonstrated an understanding of 'placebo' and 'double blinding' were significantly more likely to perceive these concepts to be acceptable than those who did not. Results indicate the need for targeted education programs that adequately inform IDUs about clinical trial concepts prior to recruitment to a clinical trial, and support adaptations of informed consent procedures to ensure trial participants' comprehensive understanding of methodologies and their implications.

Copyright 2009, Elsevier Science

Donovan RH. Toward an understanding of factors influencing athletes' attitudes about performance-enhancing technologies: Implications for ethics education. (Chapter 6). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of the first section of the book dealing with the historical and cultural context of performance-enhancing technology by athletes. This chapter addresses the factors which influence athletes' decisions about the use of performance-enhancing technologies in sports. In light of this there is also discussion of the ethnical implication of these views.

Copyright 2011, Project Cork

du Toit JA. A case for tobacco content regulation by the US Food and Drug Administration. Current Oncology 17(4): 178-180, 2010. (3 refs.)

Although many people welcome the recent move by the United States to give its Food and Drug Administration (FDA) the authority to regulate the content of tobacco, some worry that such regulation constitutes unwarranted interference with the freedom of competent adult tobacco consumers. The concern for protecting the autonomy of individuals is valuable indeed, but given the highly addictive nature of tobacco products (and especially the nicotine in tobacco products), the continued use of tobacco by smokers cannot -- without straining credulity -- be said to be autonomous. This fact, combined with a proper construal of the FDA'S role and an appreciation of the substantial morbidity and mortality associated with tobacco use, makes a strong case for content regulation.

Copyright 2010, MultiMed

Enoch MA; Johnson K; George DT; Schumann G; Moss HB; Kranzler HR et al. Ethical considerations for administering alcohol or alcohol cues to treatment-seeking alcoholics in a research setting: Can the benefits to society outweigh the risks to the individual? (review). Alcoholism: Clinical and Experimental Research 33(9): 1508-1512, 2009. (22 refs.)

The purpose of this commentary, distilled from ideas put forth at a roundtable at the 2008 RSA Annual Meeting, is to discuss whether the administration of alcohol to treatment-seeking alcoholics is ever justified. Can it ever be ethical to induce craving or give alcohol to treatment seeking, abstinent alcoholics? Can the benefits to society outweigh the risks to the individual? Can these risks be reduced to acceptable levels? What safeguards are currently in place and what research is currently being done in this domain? Can this whole issue be avoided by conducting research on alcoholics who choose harm reduction (reduced alcohol consumption) rather than abstinence as a treatment goal? The issue of administering alcohol to treatment-seeking alcoholics has been raised periodically and indeed there are national guidelines. This commentary will examine the issues described above in the context of the National Advisory Guidelines.

Copyright 2009, Research Society on Alcoholism

Fam KS; Waller DS; Yang ZL. Addressing the advertising of controversial products in China: An empirical approach. Journal of Business Ethics 88(Supplement 1): 43-58, 2009. (83 refs.)

China is a country that has undertaken a great transformation since the late 1970's, and among these changes, has seen a massive growth in the advertising industry with the influx of foreign advertisers, and the development of regional and global media, such as satellite television and the Internet. This has resulted in the Chinese people of all ages having a greater opportunity of exposure to different types of advertising, including the advertising of potentially controversial products, which could clash with traditional Chinese values. Using a stakeholder theory approach, this study analyzes the responses of 630 Chinese respondents to discover who is offended by controversial advertisements and determine ways potentially offensive advertising messages can be reduced, thereby assisting marketers in being more socially responsible in their advertising messages.

Copyright 2009, Springer

Festinger DS; Dugosh KL; Croft JR; Arabia PL; Marlowe DB. Corrected feedback: A procedure to enhance recall of informed consent to research among substance abusing offenders. Ethics & Behavior 20(5): 387-399, 2010. (52 refs.)

This study examined the efficacy of corrected feedback for improving consent recall throughout the course of an ongoing longitudinal study. Participants (N = 135) were randomly assigned to either a corrected feedback or a no-feedback control condition. Participants completed a consent quiz 2 weeks after consenting to the host study and at months 1, 2, and 3. The corrected feedback group received corrections to erroneous responses and the no-feedback control group did not. The feedback group displayed significantly greater recall overall and in specific content areas (i.e., procedures, protections, risks/benefits). Results support the use of corrected feedback for improving consent recall.

Copyright 2010, Lawrence Erlbaum

Fitzpatrick KM; Myrstol B. The jailing of America's homeless: Evaluating the rabble management thesis. Crime & Delinquency 57(2): 271-297, 2011. (57 refs.)

The authors of this article test hypotheses derived from Irwin's rabble management thesis. The analysis uses data from 47,592 interviews conducted with jailed adults in 30 U. S. cities as part of the Arrestee Drug Abuse Monitoring program. Clearly, homeless persons are overrepresented among those arrested and booked into local jails. Bivariate analysis support a fundamental assertion of the rabble management thesis: Homeless are jailed not because of their dangerousness but rather their offensiveness. Homeless arrestees are distinct from their domiciled counterparts in terms of sociodemographic characteristics, previous experiences with alcohol and drug treatment, mental health, criminal justice systems, and alcohol and drug use histories. In addition, homeless are less likely than domiciled arrestees to be jailed for felonies and violent crimes but more likely to be charged with maintenance and property crimes. Logistic regression models confirm these differences, even after other factors are controlled. A discussion of the policy implications of these findings follows.

Copyright 2011, Sage Publications

Foddy B. Addicted to food, hungry for drugs. Neuroethics 4(2, special issue): 79-89, 2011. (47 refs.)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is a disease in the same sense as addiction is usually claimed to be a disease-that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction.

Copyright 2011, Springer

Forlini C; Racine E. Autonomy and coercion in academic "cognitive enhancement" using methylphenidate: Perspectives of key stakeholders. Neuroethics 2(3): 163-177, 2009. (34 refs.)

There is mounting evidence that methylphenidate (MPH; Ritalin) is being used by healthy college students to improve concentration, alertness, and academic performance. One of the key concerns associated with such use of pharmaceuticals is the degree of freedom individuals have to engage in or abstain from cognitive enhancement (CE). From a pragmatic perspective, careful examination of the ethics of acts and contexts in which they arise includes considering coercion and social pressures to enhance cognition. We were interested in understanding how university students, parents of university students, and healthcare providers viewed autonomy and coercion in CE using MPH. We found that perspectives converged on the belief that CE is a matter of personal and individual choice. Perspectives also converged on the existence of tremendous social pressures to perform and succeed. Parents emphasized personal responsibility and accountability for CE choices, and expressed feelings of worry, sadness and fear about CE. Students emphasized the importance of personal integrity in CE, expressed tolerance for personal choices of others, and highlighted the challenge that CE poses to maintaining one's personal integrity. Healthcare providers emphasized the health consequences of CE. These results illustrate: (1) the importance of understanding how context is viewed in relation to perspectives on autonomous choice; (2) the limitations of individualistic libertarian approaches that do not consider social context; and (3) the ethical implications of public health interventions in a value-laden debate where perspectives diverge.

Copyright 2009, Springer

Friedman LC. Tobacco industry use of corporate social responsibility tactics as a sword and a shield on secondhand smoke issues. Journal of Law, Medicine & Ethics 37(4): 819-827, 2009. (15 refs.)

The tobacco industry has used corporate social responsibility tactics to improve its corporate image with the public, press, and regulators who increasingly have grown to view it as a merchant of death. There is, however, an intractable problem that corporate social responsibility efforts can mask but not resolve: the tobacco industry's products are lethal when used as directed, and no amount of corporate social responsibility activity can reconcile that fundamental contradiction with ethical corporate citizenship. This study's focus is to better understand the tobacco industry's corporate social responsibility efforts and to assess whether there has been any substantive change in the way it does business with regard to the issue of exposure to secondhand smoke. The results show that the industry has made no substantial changes and in fact has continued with business as usual. Although many of the tobacco companies' tactics traditionally had been defensive, they strove for a way to change to a more offensive strategy. Almost without exception, however, their desire to appear to be good corporate citizens clashed with their aversion to further regulation and jeopardizing their legal position, perhaps an irreconcilable conflict. Despite the switch to offense, in 2006 a federal judge found the companies guilty of racketeering.

Copyright 2009, American Society of Law, Medicine & Ethics

Garcia V. Bi-national substance abuse research and internal review boards: Human subject risks and suggestions for protections. Human Organization 68(3): 350-357, 2009. (14 refs.)

Drug use research that involves transnational populations in their worksite nations and in their countries of origin requires special consideration for human subjects. These populations are exposed to similar, if not greater, research related risks than other vulnerable research subjects. If they are to be protected adequately, Internal Review Boards (IRBs) need to become familiar with transnational populations and the possible risks that their members face when participating in research that targets their drug use behaviors and practices. Addressed in this article are a number of challenges that IRBs in United States universities and research institutes encounter in assuring protections against possible research risks. Specific areas of concern are: the dearth of bi-national IRB reviews, IRB inexperience with transnational populations, mandatory written consent, limited research ethics training for researchers, the absence of a vulnerable population research advisory board, and the need for measures in case of a breach of confidentiality. The discourse of each one of these problem areas includes a recommendation for rectifying it. The article ends with five suggested measures that IRBs should consider in protecting transnational migrants from research related risks in the United States and in their homeland. The discussion of human subject problems and of the measures introduced to alleviate them are based on the author's experiences with preparing human subjects protocols for his ethnographic substance abuse research in both the United States and Mexico.

Copyright 2009, Society for Applied Anthropology

Gavaghan C. "You can't handle the truth": Medical paternalism and prenatal alcohol use. Journal of Medical Ethics 35(5): 300-303, 2009. (15 refs.)

The publication of the latest contribution to the alcohol-in-pregnancy debate, and the now customary flurry of media attention it generated, have precipitated the renewal of a series of ongoing debates about safe levels of consumption and responsible prenatal conduct. The University College London (UCL) study's finding that low levels of alcohol did not contribute to adverse behavioural outcomes-and may indeed have made a positive contribution in some cases-is unlikely to be the last word on the subject. Proving a negative correlation is notoriously difficult ( technically, impossible), and other studies have offered alternative claims. The author is not an epidemiologist, and the purpose of this article is not to evaluate the competing empirical claims. However, the question of what information and advice healthcare practitioners ought to present to pregnant women, or prospectively or potentially pregnant women, in a situation of uncertainty is one to which healthcare ethicists may have a contribution to make. In this article, it is argued that the total abstinence policy advocated by the UK's Department of Health, and even more stridently by the British Medical Association, sits uneasily with recent data and is far from ethically unproblematic. In particular, the "precautionary'' approach advocated by these bodies displays both scant regard for the autonomy of pregnant and prospectively pregnant women and a confused grasp of the principles of beneficence and non-maleficence.

Copyright 2009, BMJ Publishing Group

Geppert CMA; Bogenschutz MP. Ethics in substance use disorder treatment. Psychiatric Clinics of North America 32(2): 283-+, 2009. (69 refs.)

Substance use disorders are a significant public health problem in the United States and because of their prevalence almost every clinician encounters ethical dilemmas in this area. Although substance abuse treatment is grounded in the principles and values of clinical ethics, the increased stigma, diminished autonomy, and lack of social justice in substance abuse treatment represent distinct contextual features. Three salient features of that distinctiveness frame this review of ethics in substance use disorders treatment. The first is social stigma and the way it has influenced confidentiality protections in substance use treatment and research. The second is the role of autonomy and personal responsibility as it relates to informed consent and decisional capacity. The third is social justice as manifested in the struggle for parity.

Copyright 2009, Elsevier Science

Geppert C; Bogenschutz MP. Pharmacological research on addictions: A framework for ethical and policy considerations. Journal of Psychoactive Drugs 41(1): 49-60, 2009. (93 refs.)

Findings from neuroscience research hold promise for improved treatments for and prevention of substance use disorders (SUD), but ethical concerns about psychopharmacological research involving SUD may potentially undermine scientific progress. This article reviews the literature pertaining to seven ethical requirements that elucidate a coherent framework for evaluating the ethics of clinical SUD research protocols. Those requirements are social or scientific value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for potential or enrolled subjects. An evidence-based analysis suggests that sound pharmacological research in SUD can safeguard the welfare of research participants while collecting valuable scientific data and benefiting society.

Copyright 2009, Haight-Ashbury Publishing

Gilmore A; Fooks G; Mckee M. The International Monetary Fund and tobacco: A product like any other? International Journal of Health Services 39(4): 789-793, 2009. (34 refs.)

The International Monetary Fund (IMF) has promoted the lifting of trade restrictions on tobacco and the privatization of state-owned tobacco industries as part of its loan conditions. Growing evidence shows that tobacco industry privatization stimulates tobacco consumption and smoking prevalence: in borrowing countries. Privatized tobacco companies make favorable tobacco control policies a condition of their investment and lobby aggressively against further control measures. This, along with increased efficiency of the private sector, leads to increases in marketing, Substantial reductions in excise taxes, drops in cigarette prices, and overall rises in sales of cigarettes. The actions of the IMF have therefore led to substantially greater use of tobacco, a product that kills half of its consumers when used as intended, with little evidence of economic gain.

Copyright 2009, Baywood Publishing

Goozner M; Caplan A; Moreno J; Kramer BS; Babor TF; Husser WC. A common standard for conflict of interest disclosure in addiction journals. Addiction 104(11): 1779-1784, 2009. (27 refs.)

This paper sets forth a common standard for conflict of interest disclosure. This common standard was drafted by the authors, following consultation with a multi-disciplinary group of journal editors, publishers, bioethicists and other academics. It is presented here for the benefit of authors, editorial managers, journal editors and peer reviewers to stimulate discussion and to provide guidance to authors in reporting real, apparent and potential conflicts of interest. It is particularly relevant to addiction specialty journals because of the potential conflicts of interest associated with funding from the alcohol, tobacco, pharmaceutical and gambling industries. Following an appropriate period of vetting the common standard within the scientific community, it is recommended that journal editors adopt journal policies and reporting procedures that are consistent across journals. [Note: There are several commentaries responding to this article.]

Copyright 2009, Society for the Study of Addiction

Green R. The ethics of sin taxes. Public Health Nursing 28(1): 68-77, 2011. (45 refs.)

The current global economic crisis is forcing governments to consider a variety of methods to generate funds for infrastructure. In the United States, smoking-related illness and an obesity epidemic are forcing public health institutions to consider a variety of methods to influence health behaviors of entire target groups. In this paper, the author uses a public health nursing model, the Public Health Code of Ethics Public Health Leadership Society, 2002), the American Nurses' Association (ANA) Code of Ethics (2001), and other relevant ethical theory to weigh and balance the arguments for and against the use of sin taxes. A position advocating the limited use of sin taxes is supported as a reasonable stance for the public health professional.

Copyright 2011, Wiley-Blackwell

Grier SA; Kumanyika S. Targeted marketing and public health. (review). Annual Review of Public Health 31: 349-369, 2010. (136 refs.)

Targeted marketing techniques, which identify consumers who share common needs or characteristics and position products or services to appeal to and reach these consumers, are now the core of all marketing and facilitate its effectiveness. However, targeted marketing, particularly of products with proven or potential adverse effects (e.g., tobacco, alcohol, entertainment violence, or unhealthful foods) to consumer segments defined as vulnerable raises complex concerns for public health. It is critical that practitioners, academics, and policy makers in marketing, public health, and other fields recognize and understand targeted marketing as a specific contextual influence on the health of children and adolescents and, for different reasons, ethnic minority populations and other populations who may benefit from public health protections. For beneficial products, such understanding can foster more socially productive targeting. For potentially harmful products, understanding the nature and scope of targeted marketing influences will support identification and implementation of corrective policies.

Copyright 2010, Annual Reviews

Gwyn PG; Colin JM. Research with the doubly vulnerable population of individuals who abuse alcohol: An ethical dilemma. Journal of Psychosocial Nursing and Mental Health Services 48(2): 38-43, 2010. (18 refs.)

Individuals who have maladaptive patterns of drinking alcohol fall into the category of vulnerable research participants for many reasons, not the least of which includes the stigma often placed on individuals who abuse alcohol. Vulnerable subgroups within the population of people who abuse alcohol include women; older adults; incarcerated, socioeconomically disadvantaged, and mentally ill individuals; as well as people from racial minorities. Thus, as research participants, individuals who abuse alcohol can be labeled a doubly vulnerable population. Belonging to more than one population simultaneously can lead to a compromised ability to protect one's own interests or greater susceptibility to harm related to participating in research studies. Arguments against including people who abuse alcohol as research participants will be presented, followed by the argument for including these individuals, which is suggested as the more ethically sound of the two points of view.

Copyright 2010, Slack

Hickman NJ; Prochaska JJ; Dunn LB. Screening for understanding of research in the inpatient psychiatry setting. Journal of Empirical Research on Human Research Ethics 6(3): 65-72, 2011. (30 refs.)

People with mental illness constitute a substantial proportion of smokers and an important population for smoking cessation research. Obtaining informed consent in this population is a critical ethical endeavor. We examined performance on a three-item instrument (3Q) designed to screen for understanding of several key elements of research: study purpose, risks, and benefits. Patients were clinically diagnosed with primary unipolar depression (n = 40), a primary psychotic disorder (n = 32), both mood and psychotic disorders (n = 17), and primary bipolar disorder (n = 14). Among an ethnically diverse sample of 124 psychiatric inpatients approached for a smoking cessation trial, 107 (86%) performed adequately on the 3Q (i.e., obtained a score of at least 3 out of a possible 6). Patients were better able to identify the study risks and benefits than to describe the study purpose. The 3Q appears to be a useful tool for researchers working with vulnerable psychiatric patients.

Copyright 2011, University ofersity of of California Press

Hughes JR. Ethical concerns about non-active conditions in smoking cessation trials and methods to decrease such concerns. (review). Drug and Alcohol Dependence 100(3): 187-193, 2009. (53 refs.)

Many have questioned whether it is ethical to assign participants in a research trial to a non-active control condition (e.g., a placebo or attention-only control) when (a) the disorder under Study is serious, (b) validated treatment is available, and (c) harm may occur if treatment is not given. This ethical concern May apply to Studies of controlled trials of treatments for drug dependence. The current paper examines this concern for trials of nicotine dependence because there are multiple validated treatments available. The major harm from assignment to a non-active condition in such a trial could occur if failure to quit discourages smokers from trying to quit again. Whether this harm actually Occurs is unclear. Potential harms from non-active conditions may be mitigated by (a) provision of more explicit information in the consent process, (b) inclusion of only those who have failed optimal treatment, (c) provision of validated treatment via a different Modality, (d) tests of the new treatment as an add-on to standard treatment, (e) use of dose-response design, (f) use of unequal randomization designs, (g) use of stopping rules, (h) provision of optimal therapy to those who fail during the study, or (i) comparison of the experimental treatment vs. standard treatment. Empirical research to inform ethical analysis of non-active conditions in drug abuse research is suggested.

Copyright 2009, Elsevier Science

Huzum E. Some obstacles to applying the principle of individual responsibility for illness in the rationing of medical services. Revista Romana De Bioetica 8(2): 104-113, 2010. (35 refs.)

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical services with limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual's responsibility for his lifestyle; 3) a patient's right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession.

Copyright 2010, Colegiul Medicilor Iasi

Johnson K; Isham A; Shah DV; Gustafson DH. Potential roles for new communication technologies in treatment of addiction. Current Psychiatry Reports 13(5): 390-397, 2011. (81 refs.)

Information and communication technologies offer clinicians the opportunity to work with patients to manage chronic conditions, including addiction. The early research on the efficacy of electronic treatment and support tools is promising. Sensors have recently received increased attention as key components of electronic treatment and recovery management systems. Although results of the research are very promising, concerns at the clinical and policy level must be addressed before widespread adoption of these technologies can become practical. First, clinicians must adapt their practices to incorporate a continuing flow of patient information. Second, payment and regulatory systems must make adjustments far beyond what telemedicine and electronic medical records have required. This paper examines potential roles of information and communication technologies as well as process and regulatory challenges.

Copyright 2011, Springer

Jorgensen S; Pedersen LJT. Not your problem? Exploring the relationship between problem formulation and social responsibility. Etikk I Praksis 5(1): 31-50, 2011. (24 refs.)

This article explores the relationship between organizational problem formulation and social responsibility. The purpose of the article is to illuminate how organizational problem formulations (1) determine the manner in which the organization attempts to solve the problem and (2) involve the ascription of significance to a group of stakeholders seen as relevant for the organization. This has implications for the degree to which they assume responsibility for those stakeholders. We discuss three dimensions of responsible decision making - rationality in goal attainment, reverence for ethical norms, and respect for stakeholders. Thereby, we arrive at an understanding of how different organizations in the same sector conceive of, and attempt to solve fundamental problems in the sector, as well as how their assumed responsibility is reflected therein. We present and discuss a case that discusses key similarities and differences between two organizations in the drug sector - a pharmaceutical company that produces medicine for the treatment of drug addiction and a foundation working with drug rehabilitation. We illuminate how the two organizations base their activities on divergent formulations of the drug problem and how this is manifested in their approach to the problem. We argue that this ultimately translates into differences in the inclusion of various stakeholders in their problem space, and thereby the degree to which they assume responsibility for key stakeholders. This contributes to the corporate social responsibility literature by providing an in depth account of how problem formulations shape organizational activities and determine the practical inclusion of stakeholders' interests in the decisions and activities of organizations.

Copyright 2011, Tapir Academic Press

Juengst ET. Annotating the moral map of enhancement: Gene doping, the limits of medicine, and the spirit of sport. (Chapter 9). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of Part II which considers conceptual maps and their ethical implications. This chapter explores the potential of gene-doping, the role of medicine, and how this influences the spirit of sport.

Copyright 2011, Project Cork

Katsiki N; Hatzitolios AI; Mikhailidis DP. Passive smoking: The democratic right of nonsmokers to survive. (editorial). Angiology 62(7): 520-522, 2011. (34 refs.)

Kious BM. Dispelling a few false-positives: A reply to MacGregor and McNamee on Doping. (commentary). Theoretical Medicine and Bioethics 32(3): 195-200, 2011. (2 refs.)

McGregor and MacNamee recently, in this journal, offered several criticisms of an earlier article in which I attempted to refute a number of arguments for the claim that doping in sports is morally wrong. Their criticisms are numerous, but focus on four domains. First, they sketch a view on which the risk profiles of different sports may make doping permissible in some and impermissible in others. Second, they suggest that my criticisms of safety-based arguments assume that doping opponents are bent on harm elimination, rather than harm management. Finally, they offer two methodological criticisms, the first pertaining to my use of analogical arguments, and the second pertaining to the general difficulties of making revisionist arguments in ethics. I defend my criticisms of safety-based arguments by showing that these do not rest on the assumptions McGregor and MacNamee attribute to me and by noting that their own view about the variable relevance of safety considerations is underdeveloped. As for their methodological arguments, I endeavor to show that these are misplaced, in that they either rest on misinterpretations of my earlier article or on an excessively high standard for ethical argumentation.

Copyright 2011, Springer

Kurtz M; Golde PB; Berlinger N. Ethical considerations in CYP2D6 genotype testing for codeine-prescribed breastfeeding mothers. (editorial). Clinical Pharmacology & Therapeutics 88(6): 760-762, 2010. (10 refs.)

In this issue, Madadi et al. report on interviews with codeine-prescribed breastfeeding mothers concerning preferences and attitudes toward receiving their CYP2D6 genotype and overall study findings. We address three sets of ethics questions raised by this article. Should genetic information be disclosed to research participants in genetic research? What should clinicians take into account when considering this genetic test in managing infant opioid toxicity risk? What conditions support or hinder the integration of genetic information into patient care?

Copyright 2010, Nature Publishing

Lecker MJ. The smoking penalty: Distributive justice or smokism? Journal of Business Ethics 84(Special Issue, Supplement 1): 47-64, 2009. (57 refs.)

This study addresses whether businesses discriminate against employees who smoke, which for the purposes of this study is called smokism. It began with a description of the employers' costs which led to the development of these smoking bans and examined several company policies as a result of these costs. The viewpoints from several perspectives toward these policies and their perceptions about smokers were also reviewed. This was followed by surveying the corporate smoking policies of 76 companies representing 287 employees in the New York City metropolitan, as well as the viewpoints of these employees on these smoking policies. Several laws regarding the rights of smokers and nonsmokers were discussed and along with the company smoking policies described earlier were compared to those firms surveyed. Next, the philosophies of Locke, Kant, Rawls, and Nozick were examined to determine whether the current smoking policies would be deemed just or discriminatory. Conclusions and implications of this research then followed the analysis of these philosophical and legislative findings.

Copyright 2009, Springer

Lee ST; Cheng IH. Assessing the TARES as an ethical model for antismoking ads. Journal of Health Communication 15(1): 55-75, 2010. (55 refs.)

This study examines the ethical dimensions of public health communication, with a focus on antismoking public service announcements (PSAs). The content analysis of 82 television ads from the U.S. Centers for Disease Control and Prevention's (CDC) Media Campaign Resource Center is an empirical testing of Baker and Martinson's (2001) TARES Test that directly examines persuasive messages for truthfulness, authenticity, respect, equity, and social responsibility. In general, the antismoking ads score highly on ethicality. There are significant relationships between ethicality and message attributes (thematic frame, emotion appeal, source, and target audience). Ads that portrayed smoking as damaging to health and socially unacceptable score lower in ethicality than ads that focus on tobacco industry manipulation, addiction, dangers of secondhand smoke, and cessation. Emotion appeals of anger and sadness are associated with higher ethicality than shame and humor appeals. Ads targeting teen/youth audiences score lower on ethicality than ads targeting adult and general audiences. There are significant differences in ethicality based on sources; ads produced by the CDC rate higher in ethicality than other sources. Theoretical implications and practical recommendations are discussed.

Copyright 2010, Taylor & Francis

Loland S. Fairness in sport: An ideal and its consequences. (Chapter 8). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of Part II which considers conceptual maps and their ethical implications. This chapter explores the sense of "fairness" as it applies to sports, and how the use or prospect of performance enhancing technologies speaks to this basic value.

Copyright 2011, Project Cork

MacGregor O; McNamee M. Harm, risk, and doping analogies: A counter-response to Kious. (editorial). Theoretical Medicine and Bioethics 32(3): 201- 207, 2011. (7 refs.)

Brent Kious has objected to our previous criticism of his views on doping, maintaining that we, by and large, misrepresented his position. In this response, we strengthen our original misgivings, arguing that (1) his views on risk of harm in sport are either uncontroversially true (not inconsistent with the views of many doping opponents) or demonstrably false (attribute to doping opponents an overly simplistic view), (2) his use of analogies (still) indicates an oversimplification of many issues surrounding the question of doping in sports, and (3) his doping analogies are insufficiently precise to support his conclusions.

Copyright 2011, Springer

Malone RE; Smith EA. Contact me soon!!! Confidential, risk-free opportunity! (editorial). Tobacco Control 18(4): 249-249, 2009. (2 refs.)

We recently both independently received an email that offered us a chance to do good and earn money for next to no work. The proposition was somewhat unethical, but the sender promised us complete confidentiality. The email concluded by asking us for an expression of interest to obtain further information about the deal. Probably most of you have received emails such as this from various "widows", "orphans", "veterans" and crooked "bank employees" from around the world. This one was different. It was from a major university research institute, asking us to consult on a project funded by Philip Morris. The project in question was an evaluation of Philip Morris's "Quit Assist" website, and each of us (and quite a large number of other people with whom we have subsequently spoken) was asked to serve as a paid "consultant". The message noted that "some scholars have decided not to take money from tobacco companies". But the writer seemed to assume that even if we were willing to take the money, we would consider it shameful; the message quickly pointed out that the compensation would be nicely laundered by the university that had received the grant from Philip Morris. Thus, no embarrassing tobacco company checks with our names on them would show up in industry document repositories.

Maschke MJ. Performance-enhancing technologies and the ethics of human subjects research. (Chapter 5). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of the first section of the book dealing with the historical and cultural context of performance-enhancing technology by athletes. This chapter addresses the performance-enhancing techniques and the ethics of using them in human subject research.

Copyright 2011, Project Cork

McNeill A; Sweanor D. Beneficence or maleficence -- big tobacco and smokeless products. (editorial). Addiction 104(2): 167-168, 2009. (7 refs.)

Mehlman MJ. Genetic enhancement in sport: Ethical, legal, and policy concerns. (Chapter 10). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of Part II which considers conceptual maps and their ethical implications. This chapter discusses the relevant science and the ethical and policy concerns that genetic enhancement has for sport.

Copyright 2011, Project Cork

Mendelevich VD. Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation. Harm Reduction Journal 8: article 15, 2011. (31 refs.)

This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation versus the majority of the countries of the world stems from differing bioethical attitudes among drug addiction treatment experts.

Copyright 2011, BioMed Central

Mendelevich VD. Substitution therapy. A new problem of biomedical ethics and medical law. Heroin Addiction and Related Clinical Problems 11(2): 41-46, 2009. (32 refs.)

Substitution maintenance therapy can be judged from different perspectives focused on its medical, legal, social, economic and ethical aspects. A subject that attracts special attention is the ethical side of substitution therapy. In the opinion of the opponents of substitution maintenance therapy, there are several key ethical problems that make this therapy immoral. From our point of view, it is unethical to refuse a patient this kind of help (substitution therapy). Substitution therapy for opioid dependence should be seen as the most ethical and humane of all methods. The absence of substitution therapy in the Russian Federation puts Russian patients in an awkward position.

Copyright 2009, European Opiate Addiction Treatment Association

Miller P; Kypri K. Why we will not accept funding from Drinkwise. (editorial). Drug and Alcohol Review 28(3): 324-326, 2009. (14 refs.)

Murray TH. Ethics and endurance-enhancing technologies in sport. (Chapter 7). IN: Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

This chapter is part of Part II which considers conceptual maps and their ethical implications, with attention to the ethical questions this raises. A central question that is raised is unequal access to expensive high technologies for increasing endurance. In the international competition, this places athletes from developing countries at a disadvantage.

Copyright 2011, Project Cork

Murray TH; Maschke KJ; Wasunna A, eds. Performance Enhancing Technologies in Sports: Ethical, Conceptual and Scientific Issues. Baltimore MD: Johns Hopkins University Press, 2009

The use of performance-improving drugs in sports dates back to the early Olympians who took an herbal tonic before competitions to augment athletic prowess. But the permissibility of doing so came into question only in the twentieth century as the popularity of anabolic steroid use and blood doping among athletes grew. Sports officials and others-aided by the development of technologies to test participants for proscribed substances-became concerned over the physical safety of athletes and competitive fairness in sporting events. This book explores the culture, ethics, and policy issues surrounding doping by competitive athletics. It also includes material drawn from accounts of former elite athletes, who discuss the meaning and value of natural talents; genetic hierarchies; and the essence of fair competition. The book examines the history and current state of drug use in sports, analyzes the distinctions between acceptable and unacceptable usage, evaluates the ethical arguments for and against permitting athletes to avail themselves of new means of improving performance, and also discusses possible future doping technologies along with the issues that they are likely to raise. There is consideration of the motivation for doping, in light of the "fair opportunity principle," and how that relates to the concept of an equal opportunity to perform. The book is organized into three parts. Part I deals the historical and cultural context, including consideration of the role of physicians, scientists, trainers, and other non-athletes, performance-enhancing technological, the ethics of human subject research, and perspectives of athletes. Part II sets forth several conceptual maps and the implications of each. This includes consideration of the concept of fairness; ethical, legal and policy concerns related to genetic endowment in sports; ethics and the endurance-enhancing technologies in sport. Part III looks to the future examining the concepts and tools of gene therapy, as well as technologies to enhance oxygen delivery and methods to detect these technologies.

Copyright 2011, Project Cork

Nash MJ; Romanos MT. An exploration of mental health nursing students' experiences and attitudes towards using cigarettes to change client's behaviour26. Journal of Psychiatric and Mental Health Nursing 17(8): 683-691, 2010. (26 refs.)

Using cigarettes to change client behaviour is a common, yet little studied, practice in mental health care. A questionnaire survey was used to explore mental health nursing student's experiences and attitudes to this practice. The sample was four cohorts of mental health nursing students (n = 151). Of them, 84% had experienced the practice of using cigarettes to change client behaviour in acute wards (73%), rehabilitation wards (28%) and elderly care (14%). Cigarettes were used to change client behaviour in areas such as attending to personal hygiene (57%) or engaging in the ward routine (39%). However, items such as leave (60%) or drinks (tea and coffee) (38%) were also reportedly used. Of the respondents, 54% inferred that the practice did not work well with 46% stating it was not written up in care plans; 52% felt it was an ad hoc practice, 60% inferred that at times it was used as a punishment while 55% intimated that they felt bad withholding cigarettes. There are ethical and moral dilemmas around using lifestyle risk factors as rewards or using client's nicotine addiction as a means of controlling behaviour. The question of whether this intervention should ever be used, given its associated health risk, requires more critical debate in clinical practice.

Copyright 2010, Wiley-Blackwell

Obot IS. Disclosing conflicts of interest: Common standards in uncommon contexts. (editorial). Addiction 104(11): 1786-1787, 2009. (5 refs.)

Ojeda VD; Robertson AM; Hiller SP; Lozada R; Cornelius W; Palinkas LA et al. A qualitative view of drug use behaviors of Mexican male injection drug users deported from the United States. Journal of Urban Health 88(1): 104-117, 2011. (55 refs.)

Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study describes illicit drug use behaviors among 24 Mexico-born male injection drug users (IDUs), >= 18 years old, residing in Tijuana, Mexico who self-identified as deportees from the United States. In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of interview transcripts identified major themes in participants' experiences. Few participants had personal or family exposures to illicit drugs prior to their first U. S. migration. Participants reported numerous deportations. Social (i.e., friends/family, post-migration stressors) and environmental factors (e. g., drug availability) were perceived to contribute to substance use initiation in the U. S. Drugs consumed in the United States included marijuana, heroin, cocaine, methamphetamine, and crack. More than half of men were IDUs prior to deportation. Addiction and justice system experiences reportedly contributed to deportation. After deportation, several men injected new drugs, primarily heroin or methamphetamine, or a combination of both drugs. Many men perceived an increase in their substance use after deportation and reported shame and loss of familial social and economic support. Early intervention is needed to stem illicit drug use in Mexican migrant youths. Binational cooperation around migrant health issues is warranted. Migrant-oriented programs may expand components that address mental health and drug use behaviors in an effort to reduce transmission of blood-borne infections. Special considerations are merited for substance users in correctional systems in the United States and Mexico, as well as substance users in United States immigration detention centers. The health status and health behaviors of deportees are likely to impact receiving Mexican communities. Programs that address health, social, and economic issues may aid deportees in resettling in Mexico.

Copyright 2011, Springer

Oriola TA. Ethical and legal analyses of policy prohibiting tobacco smoking in enclosed public spaces. Journal of Law, Medicine & Ethics 37(4): 828-840, 2009. (39 refs.)

A spate of legislations prohibiting cigarette smoking in enclosed public spaces, mainly on grounds of public health protection, recently swept across cities around the world. This is in tandem with a raft of increasingly restrictive national laws that emerged on the back of the ratification of the WHO Framework for Tobacco Control by more than one 168 countries in 2005. The central debate on the increasingly restrictive tobacco laws revolves on the extent to which public health interests justification should ground political intervention in a private right as basic as tobacco smoking, which interestingly is often lumped in the food and beverage category. The pertinent legal and ethical questions therefore are the following: Is or should there be a general unrestricted right to tobacco smoking? If there were such a right, should public health or ethical considerations trump private right to smoke in enclosed public spaces? And if public health interests were so paramount, should they go farther and ground tobacco smoking proscription in all private and public spheres? Using ethical principles and rights-based arguments, the paper critically examines the legal and ethical ramifications of public health justification for tobacco smoking proscription in enclosed public spaces.

Copyright 2009, American Society of Law, Medicine & Ethics

Otanez M; Glantz SA. Social responsibility in tobacco production? Tobacco companies' use of green supply chains to obscure the real costs of tobacco farming. Tobacco Control 20(6): 403-411, 2011. (135 refs.)

Background Tobacco companies have come under increased criticism because of environmental and labour practices related to growing tobacco in developing countries. Methods Analysis of tobacco industry documents, industry websites and interviews with tobacco farmers in Tanzania and tobacco farm workers, farm authorities, trade unionists, government officials and corporate executives from global tobacco leaf companies in Malawi. Results British American Tobacco and Philip Morris created supply chains in the 1990s to improve production efficiency, control, access to markets and profits. In the 2000s, the companies used their supply chains in an attempt to legitimize their portrayals of tobacco farming as socially and environmentally friendly, rather than take meaningful steps to eliminate child labour and reduce deforestation in developing countries. The tobacco companies used nominal self-evaluation (not truly independent evaluators) and public relations to create the impression of social responsibility. The companies benefit from $1.2 billion in unpaid labour costs because of child labour and more than $64 million annually in costs that would have been made to avoid tobacco-related deforestation in the top 12 tobacco growing developing countries, far exceeding the money they spend nominally working to change these practices. Conclusions: The tobacco industry uses green supply chains to make tobacco farming in developing countries appear sustainable while continuing to purchase leaf produced with child labour and high rates of deforestation. Strategies to counter green supply chain schemes include securing implementing protocols for the WHO Framework Convention on Tobacco Control to regulate the companies' practices at the farm level.

Copyright 2011, BMJ Publishing

Pentz RD; Berg CJ. Smoking and ethics: What are the duties of oncologists? Oncologist 15(9): 987-993, 2010. (49 refs.)

The World Health Organization's 2009 report on the world's tobacco epidemic predicts that, unchecked, tobacco use will kill a billion people in this century. Oncologists have a special professional role to play in combating this epidemic. Based on two views of professionalism, this editorial argues that oncologists have three duties. First, oncologists should be role models. They should not smoke themselves and urge their colleagues to do the same. Second, oncologists must strongly advise their own patients to stop smoking and advocate for tobacco-free environments in their patients' communities. Third, oncologists have duties to their international colleagues. They should share their experience in combating tobacco use with them, encourage and assist them to quit smoking, and help them advocate for smoke-free environments. Further, oncologists should work to ratify the Framework Convention on Tobacco Control in their own country.

Copyright 2010, Alphamed Press

Petticrew MP; Lee K. The "Father of Stress" meets "Big Tobacco": Hans Selye and the tobacco industry. American Journal of Public Health 101(3): 411-418, 2011. (98 refs.)

The concept of stress remains prominent in public health and owes much to the work of Hans Selye (1907-1982), the "father of stress." One of his main allies in this work has never been discussed as such: the tobacco industry. After an analysis of tobacco industry documents, we found that Selye received extensive tobacco industry funding and that his research on stress and health was used in litigation to defend the industry's interests and argue against a causal role for smoking in coronary heart disease and cancer. These findings have implications for assessing the scientific integrity of certain areas of stress research and for understanding corporate influences on public health research, including research on the social determinants of health.

Copyright 2011, American Public Health Association

Plebani JG; Oslin DW; Lynch KG. Examining naltrexone and alcohol effects in a minority population: Results. from an initial human laboratory study. American Journal on Addictions 20(4): 330-336, 2011. (32 refs.)

Prior clinical findings have indicated a potential lack of naltrexone efficacy among African Americans with alcohol dependence. However, no definitive conclusions have been drawn due to the relatively small numbers of African Americans in most alcohol treatment trials. The purpose of this study was to examine alcohol and naltrexone effects on healthy African-American individuals in a laboratory environment. Nonalcohol-dependent social drinking adults of African descent (n = 43) were recruited for participation. After consenting and completing the baseline assessment, they participated in four separate alcohol challenge sessions each separated by at least 10 days. During each of the sessions, subjects were administered alcohol or sham drinks, after pretreatment with either naltrexone (50 mg/day) or placebo in a double-blind fashion. The order of the four sessions was randomly assigned. During each session, breath alcohol levels and subjective responses were measured. Results indicate an alcohol effect among these subjects for subjective responses, but no naltrexone effect. Similar to the apparent lack of clinical efficacy findings, naltrexone does not appear to impact alcohol effects in African-American social drinkers. Future studies should investigate African-American populations with heavy drinking as well as alcohol-dependent subjects in order to strengthen the parallels to clinical findings.

Copyright 2011, Wiley-Blackwell

Racine E; Forlini C. Cognitive enhancement, lifestyle choice or misuse of prescription drugs? Ethics blind spots in current debates. Neuroethics 3(1): 1-4, 2010. (19 refs.)

The prospects of enhancing cognitive or motor functions using neuroscience in otherwise healthy individuals has attracted considerable attention and interest in neuroethics (Farah et al, Nature Reviews Neuroscience 5:421-425, 2004; Glannon Journal of Medical Ethics 32:74-78, 2006). The use of stimulants is one of the areas which has propelled the discussion on the potential for neuroscience to yield cognition-enhancing products. However, we have found in our review of the literature that the paradigms used to discuss the non-medical use of stimulant drugs prescribed for attention deficit/hyperactivity disorder (ADHD) vary considerably. In this brief communication, we identify three common paradigms-prescription drug abuse, cognitive enhancement, and lifestyle use of pharmaceuticals-and briefly highlight how divergences between paradigms create important "ethics blind spots".

Copyright 2010, Springer

Ross D; Kincaid H; Spurred D; Collins P, eds. Cambridge MA: MIT Press, 2010

The image of the addict in popular culture combines victimhood and moral failure. Whether in novels or films, the common response is one of sympathy, due to the character's suffering and his or her hard-won knowledge. However, the scientific knowledge about addiction tends to undermine this cultural construct. This volume includes essays by leading figures in the research community, from the neurosciences, psychology, genetics, philosophy, economics, policy. These writings grapple with questions such as whether addiction is one kind of condition, or several; whether addiction is at its cored neurophysiological, psychological, or social, or incorporates aspects of all of these; to what extent addicts are responsible for their problems, and how this affects health and regulatory policies; and whether addiction is determined by inheritance or environment or both. In these chapters this discussion is interwoven with the underlying critical question as to whether there is the possibility of a unifying basis for different addictions (substance addiction and behavioral addictions, offering both neurally and neuroscientifically grounded accounts as well as discussions of the social context of addiction. There can be no definitive answer yet to the question posed by the title of this book; but these 16 essays, involving 27 contributors demonstrates a sweeping advance over the simplistic notions that surround us. What is Addiction?

Copyright 2011, Project Cork

Sarang A; Rhodes T; Sheon N; Page K. Policing drug users in Russia: Risk, fear, and structural violence. Substance Use & Misuse 45(6): 813-835, 2009. (65 refs.)

We undertook qualitative interviews with 209 injecting drug users (IDUs) (primarily heroin) in three Russian cities: Moscow, Barnaul, and Volgograd. We explored IDU's accounts of HIV and health risk. Policing practices and how these violate health and self, emerged as a primary theme. Findings show that policing practices violate health and rights directly, but also indirectly, through the reproduction of social suffering. Extrajudicial policing practices produce fear and terror in the day-to-day lives of drug injectors, and ranged from the mundane (arrest without legal justification; the planting of evidence to expedite arrest or detainment; and the extortion of money or drugs for police gain) to the extreme (physical violence as a means of facilitating "confession" and as an act of "moral" punishment without legal cause or rationale; the use of methods of "torture"; and rape). We identify the concept of police bespredel-living with the sense that there are "no limits" to police power-as a key to perpetuating fear and terror, internalized stigma, and a sense of fatalist risk acceptance. Police besprediel is analyzed as a form of structural violence, contributing to "oppression illness." Yet, we also identify cases of resistance to such oppression, characterized by strategies to preserve dignity and hope. We identify hope for change as a resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering. Future drug use(r)-related policies, and the state responses they sponsor, should set out to promote public health while protecting human rights, hope, and dignity.

Copyright 2009, Taylor & Francis

Sarin E; Samson L; Sweat M; Beyrer C. Human rights abuses and suicidal ideation among male injecting drug users in Delhi, India. International Journal of Drug Policy 22(2): 161- 166, 2011. (56 refs.)

Background: Human rights abuses, denial of care, police surveillance, and violence directed at IDUs have been found to impact HIV prevention efforts due to decreased attendance in harm reduction programs. The association of mental health status with rights abuses has not been examined extensively among drug users. In India, drug control laws are often in conflict with harm reduction policies, thus increasing the likelihood of rights abuses against IDUs. The purpose of this study was to describe human rights abuses occurring among IDUs in Delhi and examine their association with suicidal ideation. Methods: 343 IDUs were recruited in two research sites in Delhi through respondent driven sampling and were interviewed with a cross sectional survey questionnaire that included items on human rights and socio demographics. Results: IDUs in the study experienced many human rights abuses. Notably among these were denial of admission into hospital (38.5%), denial of needles and syringes (20%), police arrests for carrying needles and using drugs (85%), verbal abuse (95%) and physical abuse (88%). Several human rights abuses were associated with suicidal ideation. These include being denied needles and syringes (OR: 7.28, 95% CI: 3.03-17.49); being arrested by police for carrying needles and using drugs (OR: 2.53,95% CI: 1.06-6.03), and being physically abused (OR: 1.66, 95% CI: 1.05-2.23). The likelihood of suicidal ideation is also strongly related to the cumulative number of abuses. Conclusions: These findings demonstrate that there is a high prevalence of human rights abuses among IDUs in Delhi. Given the alarming rate of suicidal ideation and its close relationship with human rights abuses it is essential that IOU interventions are executed within a rights-based framework.

Copyright 2011, Elsevier Science

Sass J. Supporting the need for rigorous enforceable disclosure policies for scientific journals. (editorial). Addiction 104(11): 1788-1789, 2009. (11 refs.)

Schermer M; Bolt I; de Jongh R; Olivier B. The future of psychopharmacological enhancements: Expectations and policies. Neuroethics 2(2): 75-87, 2009. (61 refs.)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed.

Copyright 2009, Springer

Sharkey K; Gillam L. Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of Medical Ethics 36(11): 661-665, 2010. (54 refs.)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive 'high tech' medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals.

Copyright 2010, BMJ Publishing

Shishani K; Nawafleh H; Jarrah S; Froelicher ES. Smoking patterns among Jordanian health professionals: A study about the impediments to tobacco control in Jordan. European Journal of Cardiovascular Nursing 10(4): 221-227, 2011. (31 refs.)

Background: Little is known about Arab health professionals' smoking practices. Aim: This is the first study to examine smoking practices among Arab health professionals. Methods: Background: Little is known about Arab nurses and physicians' smoking patterns. Aim: This study aims to examine smoking patterns among Arab nurses and physicians. Methods: A total of 918 nurses and physicians participated in this study. Data were collected using the Global Professional Health Survey. Results: About 38.8% are current smokers. The smoking percentages for male nurses and male physicians were high (83.8%, 94.6% respectively) compared to female nurses and female physicians (16.2%, 5.4% respectively). Approximately 53.8% wanted to quit and 60.6% had made previous quit attempts that lasted for more than two days. About 64.1% believed that nurses and physicians who smoke were less likely to advise patients to stop smoking. The predictors of smoking were: age when tried first cigarettes OR=6.36, 95% CI=4.48, 9.04; father smokes OR = 1.95, 95% CI =1.40, 2.72; mother smokes OR = 1.99, 95% CI = 1.18, 3.39; shift work OR = 1.45, 95% CI = 1.04, 2.03; and the interaction (gender and profession) OR = 1.82, 95% CI=1.55, 2.14. Discussion: Effective interventions begin with and/or depend on nurses and physicians being committed to smoking cessation. Given the very high smoking rates among nurses and physicians a key priority must be to provide quit smoking programs and to enable them to become effective champions of smoking cessation nationwide.

Copyright 2011, European Society of Cardiology

Stenius K; Babor TF. The alcohol industry and public interest science. Addiction 105(2): 191-198, 2010. (38 refs.)

Aims: This report argues that the growing involvement of the alcohol industry in scientific research needs to be acknowledged and addressed. It suggests a set of principles to guide ethical decision-making in the future. Methods: We review relevant issues with regard to relationships between the alcohol industry and the international academic community, especially alcohol research scientists. The guiding principles proposed are modelled after expert committee statements, and describe the responsibilities of governmental agencies, the alcohol industry, journal editors and the academic community. These are followed by recommendations designed to inform individuals and institutions about current 'best practices' that are consistent with the principles. Findings and conclusions: Growing evidence from the tobacco, pharmaceutical and medical fields suggests that financial interests of researchers may compromise their professional judgement and lead to research results that are biased in favour of commercial interests. It is recommended that the integrity of alcohol science is best served if all financial relationships with the alcoholic beverage industry are avoided. In cases where research funding, consulting, writing assignments and other activities are initiated, institutions, individuals and the alcoholic beverage industry itself are urged to follow appropriate guidelines that will increase the transparency and ethicality of such relationships.

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs

Stevens A. Drug policy, harm and human rights: A rationalist approach. International Journal of Drug Policy 22(3): 233-238, 2011. (58 refs.)

Background: It has recently been argued that drug-related harms cannot be compared, so making it impossible to choose rationally between various drug policy options. Attempts to apply international human rights law to this area are valid, but have found it difficult to overcome the problems in applying codified human rights to issues of drug policy. Method: This article applies the rationalist ethical argument of Gewirth (1978) to this issue. It outlines his argument to the 'principle of generic consistency' and the hierarchy of basic, nonsubtractive and additive rights that it entails. It then applies these ideas to drug policy issues, such as whether there is a right to use drugs, whether the rights of drug 'addicts' can be limited, and how different harms can be compared in choosing between policies. Result: There is an additive right to use drugs, but only insofar as this right does not conflict with the basic and nonsubtractive rights of others. People whose freedom to choose whether to use drugs is compromised by compulsion have a right to receive treatment. They retain enforceable duties not to inflict harms on others. Policies which reduce harms to basic and nonsubtractive rights should be pursued, even if they lead to harms to additive rights. Conclusion: There exists a sound, rational, extra-legal basis for the discussion of drug policy and related harms which enables commensurable discussion of drug policy options.

Copyright 2011, Elsevier Science

Stokes AQ; Rubin D. Activism and the limits of symmetry: The public relations battle between Colorado GASP and Philip Morris. (review). Journal of Public Relations Research 22(1): 26-48, 2010. (107 refs.)

Litigation has forced tobacco companies like Philip Morris to disclose more than 7 million internal documents, including previously confidential public relations plans. We draw from this archive, as well as from activist materials, to demonstrate that, despite vigorous industry efforts to thwart them, activists in this case employed strategies of values advocacy and inoculation and capitalized on economic benefits to persuade publics. This watershed case poses continued challenges for the 2-way symmetrical or mixed-motive theoretical model of public relations. Accounting for public relations activism and understanding its voice in influencing contemporary public debate requires that scholars move beyond this widely accepted model that stresses compromise between activists and organizations. An alternative rhetorical theory of activist public relations is posited to account for groups that refuse to accommodate opponents.

Copyright 2010, Taylor & Francis

Striley CW. A review of current ethical concerns and challenges in substance use disorder research. (review). Current Opinion in Psychiatry 24(3): 186-190, 2011. (33 refs.)

Purpose of review: To consider and summarize provocative and important publications from 2009 and 2010 related to the ethics of international substance use disorder research. Recent findings: This review highlights publications related to the interconnected areas of responsible conduct of research, human participant protections and the increasingly important area of community concerns in research, all within the larger realm of ethical concerns. Ongoing concerns highlighted include standards for conflict of interest, recruitment and remuneration practices. Other literature discussed expands the ethical dialogue to consider the community perspective on research, stigmatization of drug users from research and the absence of the 'moral voice' of drug users in ethical decision-making. Summary: Ethical dilemmas are inherent in the pursuit of any research; in substance use disorder research, often situated in a community with at-risk populations, questions such as who sets the research agenda and what norms are followed are critically important. Responsible research that protects participants and their communities internationally requires ongoing vigilance.

Copyright 2011, Lippincott, Williams & Wilkins

Taleff MJ. New York: Springer Publishing, 2009

Ethical decision-making is required in many of the difficult situations faced by addiction professionals. This guide demonstrates how critical thinking skills can impact and improve the process of ethical decision-making. This is a guide not on "what to do" when confronted with difficult ethical dilemmas, but on how to think about what to do. The author presents common ethical dilemmas that addiction professionals face in their daily work--such as boundary issues, confidentiality, dual relationships. Readers are then urged to consider their own responses to these dilemmas. The book then shows readers how to apply new models of ethical thinking into the clinical sphere. It is suggested that clinicians consider an ethical self-exam to encourage critical thinking about one's own usual and/or decision-making method. It describes several models of ethical decision making, such as the social contract theory, existentialist theory, and ethical egoism. There is attention as well to on how biases, emotional reactions, and fallacies in thought can weaken ethical decision-making. Several tools are included, e.g., an "Ethics Judgment Kit," which sets forth a simple, practical approach for decision-making. Advanced Ethics for Addiction Professionals

Copyright 2011, Project Cork

Thomson G; Wilson N; Blakely T; Edwards R. Ending appreciable tobacco use in a nation using a sinking lid on supply. Tobacco Control 19(5): 431-435, 2010. (76 refs.)

We discuss some of the practical and ethical questions that may arise for a jurisdiction where a sinking lid endgame strategy for tobacco supply is implemented. Such a strategy would involve regular required reductions in the amount of tobacco released to the market for sale sufficient to achieve the desired level of commercial sales by a target date. Tobacco manufacturers would periodically bid to the government for a residual quota. Prices would increase as supply reduced. The price level would be influenced by demand which in turn would reflect the impact of other interventions to reduce demand and the changing normality of smoking. Higher priced tobacco could result in increased smuggling, theft, illegal sales and short to medium term aggravation of some social inequalities. We suggest that the strategy be introduced in conjunction with a range of complementary interventions that would help reduce demand and thus help ensure that the possible adverse effects are minimised. These complementary interventions include providing comprehensive best practice smoking cessation support, better information to smokers and the public strengthened regulation of tobacco retailing and supply further controlling the pack and product design measures to restrict supplies that bypass the increases in product price strengthened enforcement and combating industry attacks. General prerequisites for a sinking lid strategy include public support for the goal of a tobacco free society and strong political leadership. The likely context for initial success in jurisdictions includes geographical isolation and/or strong border controls absence of significant tobacco production and/or manufacturing and low government corruption.

Copyright 2010, BMJ Publishing

Thurstone C; Salomensen-Sautel S; Riggs PD. How adolescents with substance use disorder spend research payments. Drug and Alcohol Dependence 111(3): 262-264, 2010. (12 refs.)

There is concern that research reimbursements to adolescents may increase substance use. However these concerns have not been examined empirically. Participants were 70 adolescents (13-19 years) with at least one non-nicotine substance use disorder (SUD) enrolled in a 12-week clinical trial of atomoxetine/placebo for attention/deficit-hyperactivity disorder (ADHD) Adolescent participants received cash reimbursement after each study visit (maximum possible=$425 over 12 weeks) Participants reported each week how they spent the previous reimbursement. Results were tallied and correlates of spending a payment on substances were examined. Results showed that 26 of 70 subjects reported spending at least one research payment on alcohol or drugs and 25 of 70 subjects reported spending at least one payment on tobacco. Comparing those who did and did not spend a research payment on alcohol/drugs those who did had more frequent baseline alcohol/drug use but did not differ in demographics (age, gender) or other clinical characteristics (ADHD, severity diagnosis of conduct disorder, number of SUD diagnoses, number of treatment sessions attended, or pre/post-change in number of days used substances in the past 28 days) Comparing those who did and did not spend a payment on tobacco those who did were slightly older and had more frequent baseline tobacco use. In conclusion a significant proportion of subjects used at least a portion of one research payment to buy alcohol drugs or tobacco. However there was little indication that research payments increased substance use.

Copyright 2010, Elsevier Science

Timmermans S; McKay T. Clinical trials as treatment option: Bioethics and health care disparities in substance dependency. (editorial). Social Science & Medicine 69(12, Special Issue): 1784-1790, 2009. (51 refs.)

Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.

Uchtenhagen AA. Ethical perspectives in caring for people living with addictions: The European experience. International Review of Psychiatry 22(3): 274-280, 2010. (39 refs.)

European policy and practice in caring for people living with addictions is based on defined values ( human rights, medical ethics) and on research evidence for the effects and impact of interventions. The focus of the paper is on risk management approaches to reduce the negative consequences of continued illicit drug use, being the ethically most debatable issue. The legal and policy positions are set by the European Council and Commission, and their translation into practice is documented centrally in the European Monitoring Centre on Drugs and Drug Addiction, showing the general trends as well as national differences. The European experience with the risk management approaches is presented in terms of research evidence on their effects and side-effects; this evidence is justifying the present practice. The perspectives for the future are set to follow the same lines, in a continued effort to find a balance of interests, in cooperation of authorities and civil society, and guided by ongoing research.

Copyright 2010, Taylor & Francis

van Beek I. Harm reduction: An ethical imperative. (editorial). Addiction 104(3): 342-343, 2009. (9 refs.)

Vicol MC; Bulgaru-Iliescu D; Astarastoae V. Informed consent in the treatment of drug-addiction. Revista Romana de Bioetica 7(3): 165-173, 2009. (18 refs.)

As a general rule of the medical therapy, no competent patient can be treated without being informed in prior on the diagnosis, on the development stage of disease with/without treatment, on complications, therapeutic alternatives, on the prognostic and before acquiring the patient's consent. Nevertheless, in the case of drug-addicted patients, this aspect faces several issues. Could drug-addicts be considered fully competent in order to authorize the commencement of a treatment? Is the subscription to a specialized drug-addiction treatment program fully voluntarily? Are coercive therapy methods ethical? This article aims at approaching the complexity of informed consent in drug-addiction treatment, starting from these dilemmas, by the presentation of a research made on drug addicts within a specific drug-addiction therapy program.

Copyright 2009, Colegiul Medicilor Iasi

Warren OJ; Leff DR; Athanasiou T; Kennard C; Darzi A. The neurocognitive enhancement of surgeons: An ethical perspective. (review). Journal of Surgical Research 152(1): 167-172, 2009. (47 refs.)

Neurocognitive enhancement is a rapidly expanding scientific field. The vast ethical implications of this developing field for surgical practice have yet to be considered within the literature. This article outlines the reasons surgeons may, in the near future, consider using neurocognitive enhancement and addresses the resulting significant ethical implications of this. We do not seek to support or denounce the potential role of neurocognitive enhancement in surgeons, but to stimulate a debate, which, with ever-increasing levels of stimulant use in schools and colleges, and with a pharmaceutical industry driving the creation of new neuroactive products, has now become a necessity.

Copyright 2009, Academic Press

Webb JR; Thomas JW; Valasek MA. Contemplaing cognitive enhancement in medical students and residents. Perspectives in Biology and Medicine 2(200-214), 2010. (76 refs.)

Medical school and residency can be stressful times, involving years of intensive academic study and pressure to earn high grades. Students and residents must learn to care for the sick, a task requiring long work hours and sleep deprivation. In such an environment, it is important to monitor the mental health of trainees and the factors that influence it. This essay examines a relatively unexplored facet of physician mental health: the use of pharmacological stimulants by students and residents to study better, earn higher grades, stay awake longer, and take better care of patients. Practical and ethical considerations of stimulant use in the medical profession, along with future directions for medical student mental health, are discussed.

Copyright 2010, Johns Hopkins University Press

Weeks MO. Tobacco and media exposure in poor neighbourhoods: Implications for the incidence of smoking among community residents. International Journal of Nursing Practice 17(5): 534-538, 2011. (12 refs.)

It is an accepted truth that tobacco, as well as second-hand smoke, causes lung and other cancers. This health policy fact sheet examines the need and implications for tobacco control legislation in the United States. Major stakeholders and special interest groups influence whether or not further tobacco control legislation can be passed and who it affects. This paper will review not only the ethical implications, such as the ethical theory, ethical principles and ethical rules of conduct that support tobacco control legislation, but also its legal and economic implications as well as media influences. This paper concludes with the authors' assessment that the United States is in fact in need of more tobacco control legislation.

Copyright 2011, Wiley-Blackwell

West R. Conflict of interest declarations: Could a 'traffic light' system work? (commentary). Addiction 104(11): 1785-1786, 2009. (1 refs.)

This commentary is a response to a an article by Goozer et al in this issue proposing a common standard for addiction journals in respect to conflict of interest disclosure. While noting that many of the suggestions are valuable, it is noted that some might be seen as creating an unnecessary and unacceptable burden. The "traffic signal" metaphor is used to indicate potential sources of bias. Simply by way of example, the following are seen as "red" indicators, although journals might differ in how each chooses to respond, be it disclosure or a decision not to publish: 1 Any receipt of funds (e.g. through employment, shares, fees, research grants) within the past 5 years from an interested party (IP). An IP is a company/industry with any financial interest in the topic of study (TOS), or an organization acting as an agent for such a company/industry in any capacity (e.g. lobbying, 'watchdog', media relations, distributing research funds); 2 Any strong religious beliefs or values directly relating to the TOS; 3 Ownership of patents, copyrights or businesses relating to the TOS, the financial gain from which could be influenced by the conclusions drawn; and 4 Grievance against, family tie with, close friendship with or close working relationship with one or more individuals who have a direct personal interest in the TOS (e.g. author of a paper being reviewed)

Copyright 2009, Society for the Study of Addiction

Wettenhall R. State enterprise for ethical reasons: Mostly alcohol and tobacco. Policy Studies 32(3, special isssue): 243-261, 2011. (83 refs.)

The impact of the global financial crisis (GFC) in 2007-2010 directed attention once more to the role of the state in the economy, with many observers accepting that that role would be larger in the foreseeable future than it had been during the privatising era of the later twentieth century. But the interventions of the GFC period and the debates about them focused very largely on commercial functions - banking and industrial production. Going beyond these particular interventions and debates, there has always been a strong, though often forgotten, case for government intervention for ethical rather than commercial reasons. This article reviews that case as it manifests itself in the alcohol and tobacco industries, with a brief indication that the betting/gambling industry presents many similar features.

Copyright 2011, Taylor & Francis Ltd

Wilson A. Research ethics and the 'iron cage' of bureaucratic rationality. (editorial). Addiction Research & Theory 19(5): 391-393, 2011. (9 refs.)

Wye P; Bowman J; Wiggers J; Baker A; Carr V; Terry M et al. An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital. Australian and New Zealand Journal of Public Health 34(3): 298-303, 2010. (43 refs.)

Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used. Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.

Copyright 2010, Public Health Association of Australia